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Impact of Multidetector CT on Donor Selection and Surgical Planning Before Living Adult Right Lobe Liver Transplantation

Ihab R. Kamel1, Jonathan B. Kruskal1, Elizabeth A. Pomfret2,3, Mary T. Keogan1, Gizele Warmbrand1 and Vassilios Raptopoulos1

1 Department of Radiology, Abdominal Imaging Section, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA 02215.
2 Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215.
3 Present address: Institute of Liver Transplantation, Lahey Clinic Medical Center, 41 Mall Rd., Burlington, MA 01805.



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  		Fig. 1A. —35-year-old man, potential liver donor. Multidetector CT scan obtained during hepatic arterial phase shows complete opacification of hepatic arteries. Maximum-intensity-projection image in thick (2.5 cm) slab along coronal oblique plane centered over porta hepatis reveals opacification of right (R) and left (L) hepatic arteries, arising from proper hepatic artery. Artery to segment IV (arrow) is well visualized, arising from right hepatic artery, approximately 3.5 cm from its origin.

 


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  		Fig. 1B. —35-year-old man, potential liver donor. Celiac angiogram reveals findings similar to A, including artery to segment IV (arrow) arising from right hepatic artery. R = right hepatic artery, L = left hepatic artery.

 


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  		Fig. 2A. —35-year-old man, potential liver donor. Multidetector CT scan obtained during portal venous phase shows complete opacification of hepatic veins. Maximum-intensity-projection image in thick (2.5 cm) slab along axial plane centered over middle hepatic vein reveals early bifurcation into two major branches (arrows).

 


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  		Fig. 2B. —35-year-old man, potential liver donor. Three-dimensional model of hepatic veins, seen from right superior oblique view, reveals early bifurcation of middle hepatic vein (arrows).

 


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  		Fig. 3A. —42-year-old woman, potential liver donor. Multidetector CT scan during portal venous phase reveals accessory inferior right hepatic vein. Maximum-intensity-projection image in thick (2.5 cm) slab along axial plane centered over mid liver reveals large accessory inferior right hepatic vein (arrow) draining directly into inferior vena cava.

 


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  		Fig. 3B. —42-year-old woman, potential liver donor. Maximum-intensity-projection image in thick (2.5 cm) slab along coronal plane reveals distance between right hepatic vein (arrowhead) and accessory inferior right hepatic vein (arrow).

 


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  		Fig. 4A. —42-year-old woman, potential liver donor. Multidetector CT scan obtained during portal venous phase shows complete opacification of portal vein. Maximum-intensity-projection image in thick (2.5 cm) slab along coronal plane reveals main portal vein (M) and right portal vein (R) dividing into anterior (A) and posterior (P) branches.

 


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  		Fig. 4B. —42-year-old woman, potential liver donor. Portal venous phase of celiac angiogram reveals findings similar to A. A = anterior, P = posterior, M = main portal vein, R = right portal vein.

 


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  		Fig. 5. —47-year-old man, potential liver donor. Shaded-surface display of portal venous system shows trifurcation of main portal vein (M) into anterior (A), posterior (P), and left (L) branches. No right portal vein trunk is seen.

 


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  		Fig. 6. —42-year-old woman, potential liver donor. Three-dimensional model of hepatic veins and liver is visualized from right superior oblique view, with superior cut to emphasize relationship of vessels to liver parenchyma. These models allow rotation in multiple planes to visualize hepatic veins from different angles. Color assignments allow visual enhancement of vascular branching of hepatic veins particularly middle hepatic vein (arrow), knowledge of which may alter surgical incision plane.

 


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  		Fig. 7. —42-year-old woman, potential liver donor. Three-dimensional model of right (R) and left (L) lobes of liver is seen in frontal view after hemihepatectomy (arrow). Color assignment of right and left lobes allows visual enhancement of relationship between liver segments.

 

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